What is vertigo anyway?
What to do during an attack
FIRST OFF, I’m not a doctor. I don’t even play one on TV. I am, however, a sufferer. And if I can help just one fellow vertigo sufferer avoid what I’ve been through over the years, I’ll be happy…
This isn’t one of those sites where you read on and on and get to the end the person is trying to sell you something. Nope, I’m just a sufferer who’s dealt with vertigo for over 35 years, telling you what I’ve learned, and what I do when I’m thrown into an attack. If you want help right now, jump to the What to Do During an Attack section and then learn about the problem later on. You can use the links above to jump ahead, or you can read the article. Whatever way is the most helpful.
SO. Here’s my story: I’ve suffered from chronic vertigo almost my entire adult life. If you’ve found this article, I’m guessing you’ve already had at least one episode of vertigo and are seeking help; or maybe you know someone who has had at least one vertigo attack and are looking for answers.
Make no mistake, the first time vertigo rears its ugly head, it is SCARY. You have no idea what’s happening. The whole world has suddenly gone freakin’ haywire — it’s spinning or moving in unpredictable ways like a scene out of Inception. Only Leonardo DiCaprio isn’t there and you want to throw up. Which, unfortunately, you might.
My first attack was over 30 years ago. I was at work, typing away at the keyboard when all of a sudden the room went to 90-degrees and back again, as if someone had come along and pushed me into my workstation. Then came the spins. The 90-degree thing over and over and over again. Whoosh whoosh whoosh whoosh. Awful! My husband was called and took me to Urgent Care, where they quickly diagnosed vertigo. I was 30 years old. This was the first time I’d heard the word other than from the Hitchcock movie. I’d always thought it meant fear of heights. (Nope, that’s acrophobia.) I was prescribed Antivert (meclizine, see below) and sent home, where it took a few days to recover.
Thirty years later, vertigo still hits out of the blue, or, if I’m lucky (sort of), I get some warning signs (see below). It often hits on a rainy day (barometric pressure?), days of high humidity (dehydration?), while doing a task with my head bent forward (head angle?), entering a room (unfamiliar surroundings?), turning over in bed (position?), in the presence of smells (sensory overload?), entering an unfamiliar store, etc. It’s usually accompanied by a sinus headache, but not always. It’s always accompanied by nausea. Mega nausea. Mega MEGA nausea. If you look up nausea in the dictionary, you will see a picture of me.
In recent years, 9 times out of 10 my vertigo attacks are accompanied by a severe headache, usually on one side of my head, in lower-right quadrant, which is often the first sign of an attack about to hit, and happens any time during the day, often first thing.
(In fact, I’ve been told by physicians that my vertigo attacks are possibly migraine, which has many of the same symptoms: pain behind face and eyes, headache, sensitivity to light and sound, feeling otherworldly, feeling like you’re in a dark tunnel, etc.) See vestibular migraine, below.
At times — before I discovered how to heed the warning signs — it came as frequently as once a month. Other times, an attack might be 6 months to a year after the last. There are months that I’m vertiginous for days on end, but still able to function. (People might notice I’m nonchalantly holding onto a table or chair, or feeling the top of a table to remind my brain that it’s horizontal.) There are days when I’m so debilitated, I’m bed-ridden and can’t walk. There are attacks that last an hour, or a day, and attacks that last a month. Oftentimes I can’t even read. Just the thought of reading, with the eyes going left and right, can make me nauseated. And there are days and weeks and months where vertigo seems like only a memory.
Vertigo 101. What is vertigo, anyway?
Basically, vertigo is the sensation that you’re moving when you’re not, or the world around you is moving when it’s not. It feels like you’re standing on a moving bus or on uneven ground when the ground is perfectly solid. Simply, it’s your brain misreading your body’s position in its surroundings. All together now: Stupid brain.
Here’s how you tell if it’s vertigo and not plain light-headedness or dizziness, although that can come with it. Remember when you were in college and you drank too much, and you had to stomp your foot on the floor to stop the room from spinning? Vertigo. Or when you were a kid and you spun in circles for fun, and when you stopped everything was spinning around you? Vertigo. Or when you’re in a car, stopped at a stop light and the car next to you moves and you’re sure it’s your car moving? Vertigo! If you want to show your friends what it’s like, have them sit in an office chair and spin them around a few times. Then stop the chair. Maybe then they won’t look at you anymore like you’re a drunken idiot. If you’ve stood up quickly and feel faint, that’s light-headedness, not vertigo.
Here’s what’s happening: your brain cannot tell which way is up. Your eyes try to grab onto something — anything — that’ll tell your brain what position your body is in. They jitter uncontrollably, involuntarily trying to make sense of things. (Nystagmus. It’s the jittering eyes that make the spin!) They’re having trouble because your brain is like, “Stop telling me this body is lying in bed! It’s at a 45.8-degree angle, not horizontal! Shut UP already!” Your eyes are like, “What? No. It’s totally lying in bed. It’s flat — flat, I tell you!” And your stomach is like, “Aaaaaaaaaah!”
To mix metaphors: You’re seasick on solid ground. You’re a merry-go-round without a brakeman. You’re an untethered Macy’s Thanksgiving Day Parade balloon. And you want to throw up. Which, you might. It’s Chaos in Balance Town! Your right inner ear thinks you’re in one position, and your left inner ear thinks you’re in another. They’re fighting it out in the street, and Sheriff Brain is like, “Nobody move! I can’t tell which of you is right!”
But… why?? Blame it on your inner ear. That’s your balance center. It’s the part of the ear that’s for balance. It’s constantly telling your brain which way is up. Check out this inner ear info There’s fluid in there, and as it touches little hairs (cilia) along the semicircular canal (which looks like that crazy space-and-time traveling thingamajobby in Contact), your brain gets signals that tell it which way is up, which way is flat, which way is vertical, etc. It’s your very own biological gyroscope.
And when it gets damaged or compromised in some way, stuff happens. Compromised inner ears can come from a head injury or from other medical reasons like disease or inflammation, or where it’s being pushed upon or inflamed by a sinus or ear infection. Some ways your inner ear might be compromised: disease, viral infection, bacterial infection, chronic sinus infections (I believe this is me), swollen or inflamed sinus cavities, pressure not equalized between one side of eustachian tube (middle ear) and the other (back of throat), or even a heart condition. It’s also a symptom of some migraines.
Sinuses can be inflamed simply from not draining properly. So fixing sinus issues is super important to fixing inner ear issues. Eustachian tube info here. It can even be caused by Temporomandibular Joint Disorders (TMD, TMJ) (misalignment and inflammation where the jaw bone where it connects to the skull. I have had TMJ issues since I was a teenager. In fact, I’ve personally gotten vertigo relief from icing my jaw! And migraines. Not all migraines have headaches!
But MOSTLY, what happens in the inner ear is that these tiny crystals of calcium carbonate called otoconia (NOT a country) have dislodged from their proper place on nerve endings within the semi-circular canal, the part of the inner ear where signals are sent to the brain about the body’s orientation. These “ear rocks” have gotten stuck in a place they don’t belong. Stupid ear rocks. Check out how the otoconia move to the wrong place in the inner ear.
Unfortunately, the older you get, the more likely you have these dislodged particles. (Which might be the reason that I’ve had more attacks in the last 7 years than in the previous 23.)
The key to getting over it is controlling inflammation while keeping fluid flowing in the inner ear to allow the crystals to move freely again. And using other parts of your body to remind your brain not to totally trust your inner ear’s balance center.
So yeah, your inner ear could be damaged by disease or injury, but typically, most bouts of vertigo are considered Benign Paroxysmal Positional Vertigo (BPPV), which means the vertigo is triggered by the angle of your head. When you move your head from one side to another (like turning over in bed), those darn &*%$#@! crystals can get stuck in a place they shouldn’t.
I’ve known people who’ve had attacks while on mountain trails who have had to be airlifted out; I’ve known people who have had to crawl to the bathroom, sure they’re going to fall through the floor. I’ve known people who have had attacks while snorkeling; while grocery shopping; while stepping out of an elevator that opens at the end of a long hall; while walking on the beach; while standing on a boat; while singing in the church choir. Vertigo does not care where you are or how inconvenient an attack is going to be. Vertigo is a fickle bitch.
So… enough of how awful it is. I’ve been asked so many times how I deal with this, I’ve decided to put down what’s helped me over the years. Statistically, one attack means more, especially as you get older, so it’s good to recognize the signals before it gets out of control.
Note: Many of the tools I’m going to list here are also appropriate for those suffering migraines, which with some kinds of vertigo occur hand-in-hand. (With vertiginous migraine, you might have a headache and no vertigo. You might have vertigo and no headache. Still a migraine.) Interestingly, migraine and vertigo sufferers might also suffer from asthma, allergies, and/or sinus headache. They’re ALL forms of your body over-reacting to stimuli. (This article tells about the connection to these problems and the nervous system.)
Vertigo can also be diagnosed as “vestibular neuritis” which means the vistibular nerve (from the inner ear to the brain) is infected with a virus. There can be lesions on this nerve. This article explains vestibular neuritis vs. labrynthitis
Warning signs an attack might be coming (if you’re lucky):
Heed the signs and take action!
- Feeling off-balance while turning around, standing up, turning over in bed, or just standing there minding your own business. This might even be your first sign. An attack might be imminent or days away.
- Severe headache, sometimes sinus pain, sometimes one side or back of head
- Things seeming “off” – this can be dreamlike sensation that the world around you isn’t quite right.
- Sensitivity to light and sound
- Tinnitus (ringing in the ears)
- Sensation you are falling, similar to when you fall asleep, only you’re not falling asleep.
- Sensitivity to smells, even innocuous ones like Windex and Elmer’s glue. Perfumes, fireplace and cigarette smoke, paints and solvents, etc. are especially bad. All of these are triggers for me.
What follows is what works for me. Remember, I’m not a doctor; I’m just a sufferer. Your doctor may not agree, so you might want to okay this course of action with them…
- First thing!! This is my go-to with the first whoosh of a room spin: SHUT YOUR EYES. Then open them. Then shut them. Then open them. Same speed as you just read, maybe a tad slower. Every time you open them, your brain sort of “resets” to what it’s seeing. Sometimes this simple thing can waylay the spin. Sometimes it’s all you need! In fact, not a bad idea to do this every now and then throughout the day. Do it 10x.
- Drink lots of water (your weight in lbs divided by 2 = ounces/day)
- Sit or lie down with head propped up by pillows. Keeping your head upright can be better than horizontal.
- Fix your gaze. Find an object across the room and focus on it. This can be extremely hard during a major attack, but it is the first thing you should do to try to gain control over a spin.
- Can’t do that? Literally hold your eyes still. Remember, the sensation of things moving is actually your eyes trying to grab onto something that’s not moving. Stopping your eyes from jittery motion can help. Don’t push hard – just gently place your fingertipss on top of your closed eyes. It’s also calming.
- Room spinning big time? Close one eye. This can sometimes calm things down.
- Take magnesium supplements. 1000 mg/day (500 mg in morning, 500 mg before bed.) This might be most important of all here! It took me 30 years to find this out, and it has reduced monthly attacks to my first 6-month break in years. Actually, I recommend taking magnesium supplements 365 days a year. Don’t wait for an attack. This is not some internet bull; my new doctor — God, where was she all those years? — says she recommends magnesium for all her patients with vertigo and with migraines. (Warning: magnesium can cause diarrhea. “Milk of Magnesia,” anyone?; try 750 mg or less if you succumb.)
- Since vertigo can coincide w/sinus issues, sinus meds can help: Antihistamines such as Claritin, Zyrtec, or Benadryl; Sudafed (decongestant), guaifenessen (e.g., Mucinex; mucus thinner; 400 mg is good 1-4x/day), and Flonase (nasal steroid that keeps sinuses open for draining).
- Ibuprofen every 4-6 hours for inflammation and headache pain.
- To relieve nausea and help with balance, meclizine is a wonder drug. 1-4x/day (it’s now OTC – for years it wasn’t; this has saved me many a doctor visit). It’s an antihistamine for motion sickness. Warning: It can make you drowsy and a little foggy-brained, so be careful not to drive or operate machinery. I find 25 mg/dose is plenty, though 12.5 mg can help me as well with less side effects. I do not take this unless I am having an attack. Buy locally so you can see expiration date.
- Other antiemetics (nausea meds) such as Phenergan (promethazine) or Zofran (ondansetran) are also helpful, but only take under doctor’s advice and prescription. Warning: Phenergan has been associated with heart arhythmia, so don’t use unless it’s the only one that works.
- Frequent cleaning of sinuses with salt water (I like Simply Saline or equivalent store brand over a neti pot*), use of steam inhaler as needed (I use this one; it puts out a lot of steam), and hot tea is also good (I really like peppermint tea like Celestial Seasonings caffeine-free peppermint or Walmart’s Great Value Peppermint). *Neti pot requires you to tilt your head. Sorry, people with chronic vertigo cannot tilt our heads.
- Apply warm compress to your face, ears, and head. I love this mask thing. If I weren’t already married, I’d marry it.
- Relax in quiet, darkened room. This calms nervous system and removes you from light and sound. Meditation and relaxation techniques are a must. Try to clear your thoughts. If you can’t clear them, only allow yourself to think of happy moments. Fill your head with moments of calm and happiness you have experienced. Stressful thoughts contract muscles; contracted muscles impede flow of bodily fluids. In fact, look into biofeedback, which can help you learn how to relax muscles and your nervous system. Stretch.
- When turning over in bed or turning around while standing, turn your whole body along with your head. Do not let your head turn and then your body.
- Keep your head elevated while sleeping as much as possible with pillows or foam wedge.
- Progressive, bifocal and trifocal lens eyeglasses can exacerbate balance issues. When reading, try separate reading glasses. At the computer, you might try single-vision glasses just for that distance. ((I personally cannot use progressive lenses because of my vertigo because they distort the world too much. I use trifocals.)
- Keep your head upright! If it means sleeping propped up in a chair or recliner, that’s what has to happen.
- If possible, avoid the dentist, the hairdresser (the sink is not your friend), and lying completely flat on your back.
- Avoid bending (in fact, avoid looking at the floor if at all possible). If you must bend to pick something up, try to keep your head upright and focused on a object across the room. Better yet, have someone else pick it up or get a grabber tool.
- When looking into cabinets or shelves above eye level, stand on a stool so your head isn’t tilted back. (Careful when putting the stool in place. Better to keep your head upright and bend at the knees than look down.)
- Arrange your workspace so that your monitor is straight ahead and don’t tilt your head to focus. Single-vision glasses just for that distance is best.
- Stay away from areas that have weird angles or visual anomalies (vaulted ceilings, patterned carpet, long hallways, narrow store aisles piled with merchandise, tunnels, etc. Blech! I get sick just thinking about a checkerboard floor!) There’s a special place in Hell for the guy who invented those advertisements on the floors at the supermarket.
- If your vertigo is linked to TMD/TMJ jaw issues — you’d be surprised, it might!! — ice your jaw just below your ear for 10 minutes followed by 10 minutes of warm. Do this 4x/day to reduce inflammation.
Compensation methods (training your brain to bypass/ignore signals from your inner ear)**
Your inner ear is not the only place your brain receives signals about your position. Your feet and limbs do, too. Your brain needs the feedback from your body. It needs to ignore what the inner ear is telling it and to listen the other stimuli your body is getting.
- Close eyes, open eyes, close eyes, open eyes. Do 10x.
- Touch the wall or furniture as you walk by, stomp on the floor, march in place, rub your leg across the bed when you’re lying down, etc. This tells the brain that things are really level and you are on solid ground. In fact, anything you can do to tell your brain what position your body is in will help. Even things like scratching your arm or leg can help! Say to yourself, “This wall is vertical.” (touch wall) “This floor is solid and horizontal.” (Stomp on floor.) “This bed is horizontal.” (sweep leg across bed or couch. – you have to be lying down for this one if it’s not obvious!)
- Whenever you change positions (like turning around), stop for a few seconds along the way to let your surroundings settle. Do the eyes closed, eyes open trick.
- When getting out of bed, rise to sitting position before rising, wait 10-30 seconds until you are sure the room is still.
- Tell your brain that you are balanced and that you are on solid ground. Say, “The floor is solid!” … “The table is horizontal!.” I mean OUT LOUD. Seriously. It listens. If you feel silly doing that, push the envelope and sing it! Ha! You already look like a drunken sailor, you might as well act like one.
- Take a walk. This is the last thing you will want to do, but it is often a life saver. It reminds your brain where your body and the ground are! WARNING: It is NOT easy. Don’t go alone. Go with someone. Take a cane or tall umbrella with you. You will find that holding onto someone else is not as steady as holding onto something inanimate. But if you don’t have a cane, grab onto your walking partner every time you feel a bit off, especially when stepping off a curb. And STOP when you start to feel that it is too taxing on your balance system. Walk 20 feet, stop; walk 20 more feet, stop, etc. Trying to soldier through a spin by continuing to move is NOT the way to get through it. Slow and steady is the name of the game.
- Walk like you drive. This means look around you as you look around you when you’re behind the wheel – left, right, etc. MOST people who have vertigo have less symptoms when they drive.
EXERCISES… Some of these will feel totally impossible if you are in full room-spinning mode. Do not do any of these unless you’re able!*
- Head movements: When you’re able to focus on an object, rotate your head gently from left to right, keeping the object in focus. Do this 10x. It works in same way a ballet dancer “spots” to keep balance. Then move head up and down 10x. Then move head diagonally (upper left to lower right and vice versa) 10x. Note: For those with progressive lenses in their eyeglasses or lenses with prisms, this might be a lot harder to do than for those with no glasses or straight lenses. Glasses that add distortion can make this extremely difficult during an episode.
- Relax. Breathe in slowly through nose to a count of 6; count to 3; exhale slowly through mouth to a count of 6.
- Relax #2: Sit upright and close eyes. (Read this first! ha!) Breathing steadily, imagine your muscles in your head relaxed; next relax the muscles in your shoulders; go down your body relaxing all your muscle groups.
- Stand still. (Yup!) Stand behind the back of chair so you have something to grab onto if need be. Hang arms at side. Try with closing eyes.
- Stretch. In sitting position, with feet grounded to floor, lift your arms if possible. Lift one leg, put it down, lift the other then put it down.
- March in place. Stomp the floor. Reminds the brain that you are in control, the floor is flat, etc.
- Stand and sway. Stand behind chair so you have something to grab onto if need be. Stand w feet shoulder-width apart. Sway left, then right. Try with eyes closed. Try also with sway forward and back, from toes to heels.
- Something new I’ve discovered: Not quite sure how to describe this, but clench (clench?) your head with the muscles that hold it up. Like a toddler who’s super angry. Hold the clench for 5-10 seconds then relax the muscles. I think the relaxation part lessens the pressure on the inner ear, or relaxes neck muscles, which can affect inner ear.
- Turn in place while standing. Turn 1/4 the way around (or less!). Stop until world settles around you. Turn another 1/4 turn, etc. Progress until you’re able to turn with your eyes closed. (What? Yup!)
- When you have mastered the focusing-on-object steps, try them by standing on a pillow. Try them while standing on one leg. Try them while standing on the beach (way hard — the sand moves, the water moves…aaaaaaah!), standing on a pier next to a boat, standing on a street corner as cars go by, etc. Again – this step only after you’ve mastered the others or when you are not suffering through an attack.
- Massage. Get yourself a chair massage. I personally cannot tolerate a table massage because it can put me into a full spin when my head is flat on the table. Shoulders, neck, back, back of head super important to relaxing tense muscles that could be causing the vertigo.
- Even when you are not suffering a vertigo attack, practice balance. Put your pants on while standing up; stand on one leg, then the other; try a balance board, etc. i.e., train your brain that balance is easy for you so that when it’s in crisis, it can more easily do what it’s used to doing. Step aerobics, dancing, riding a bike, hiking, sports, etc. are good balancing practice. When you’re not in the throes of an attack, that is!
Lastly, if you’re game, there are positional maneuvers you can do (or have done to you by a medical professional). I personally have not had much luck with these, but I would be remiss in not mentioning them. Perhaps they haven’t worked for me due to the nature of my vertigo (vertiginous migraine? unknown!), or it might be due to where the crystals tend to get stuck and I have been trying the wrong ones.
Also, I would never attempt if I was in Level 8 or higher unless I’m in a doctor’s office. (Hadn’t yet mentioned: I rate my attacks from 1 to 10, 10 being the whole room is spinning spinning spinning. At Level 8, I cannot walk without holding onto everything in my path and am a step away from throwing up.) In times of desperation I have done these but they only seem to work for a short period of time. This, of course, is me. A short description at each, but please watch the videos linked here to have a better idea of what is happening…
- The Epley Maneuver* Your head is moved to specific angles in a specific order (or someone moves it for you) to dislodge those crystals. Note how they say to stay upright afterwards!! i.e., no lying down, looking down, or bending to pick something up! *btw, these PT guys are my go-to PTs for everything from vertigo to frozen shoulder. They’re fun AND they’re good.
- The Somersault Maneuver. You kneel on the floor and lean forward as if about to do a somersault, then angle your head toward the ear that is causing the issues. Warning: One time I did the somersault maneuver and the floor felt like it was at 45-degrees. I literally felt like I was holding onto the carpet for dear life, swearing I would never ever do this again!
- Brandt-Daroff exercise. Sit on the edge of a bed or sofa and quickly lie down on the side that causes the worst vertigo, wait until the vertigo subsides (hopefully within 30 seconds), sit up, wait for it to subside, repeat on other side. What I do is a variation of that and I called it the “I’m Desperate, It Works Method.” Most sufferers will say, “Are you insane?” when I tell them this. I sit on edge of bed, throw myself backward, thrash my head left and right a few times, then quickly sit up. I do it like 3x. It says to the crystals, “Get. The. Hell. Out. Of. There.” That said, it will fix it, but it will only last a few hours.
- The Deep Head Hanging Method You lie on your back and hang your head over the edge of the bed. I haven’t tried it yet, but next time I will for sure. The video linked here includes a helpful animation showing what’s going on inside the inner ear as you’re moving into and out of position.
**Many taught to me by the good folks at California Ear Institute, Palo Alto, CA. Check out their really good explanation of BPPV and from the American Hearing Research Foundation … Super good article on BPPV that goes into exercises mentioned above as well as daily how-to-deal-with-it advice.
Article on Vertiginous Migraine.
This article is really good, too!
As I think of more ways to cope, I will add to the list. I hope this list helps someone out there!
–D. S. Thornton, vertigo sufferer